PRACTICE MANAGEMENTUSEFUL LINKS
CMS PHYSICIAN FEE SCHEDULECMS Physician Fee Schedule look-up provides information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services, the associated relative value units, a fee schedule status indicator and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.). Physician Fee Schedule Look-up - https://www.cms.gov/medicare/physician-fee-schedule/search CMS CY 2025 FINAL RULEThe CY 2025 Medicare Physician Fee Schedule final rule, as summarized by CMS, includes several notable updates to physician payment policies, the Quality Payment Program (QPP), and the Medicare Shared Savings Program (MSSP). A significant change is the 2.83% reduction in the conversion factor, which decreases from $33.288 to $32.347, with the anesthesia conversion factor also reduced from $20.774 to $20.318. These reductions, mandated by statute, continue to challenge providers, though organizations like the AOA are advocating for legislative changes to address them. Disclaimer: These documents are intended for informational purposes only and is based on summaries derived from multiple sources. While we strive for accuracy, these links are not official source documents. We strongly recommend consulting the original source material or the Centers for Medicare & Medicaid Services (CMS) directly to verify the information and ensure compliance with all applicable policies and guidelines. HOW TO RESPOND TO MEDICAL RECORD REQUESTS (AUDITS)AAO ASSISTANCE FOR PRACTICE MANAGEMENTThe AAO understands the difficulties members face with practice management issues (e.g., claims denial, documentation, coding, etc.). A new member benefit will provide you with support in navigating these issues. Our staff has partnered with Sunrise2Sunrise Home Services (SR2) to answer your questions, provide useful information, and find effective solutions. SR2 has more than 20 years of experience in the clinical, practice management, payment resolution and revenue cycle arenas. They have expertise in Medicare and commercial payers’ reimbursement policies and developing Current Procedural Terminology (CPT) codes through the American Medical Association’s CPT editorial Panel and the subsequent valuation of physician services and procedures the Relative Value Scale Update Committee (RUC) processes. Additionally, SR2 has experience working with osteopathic physicians and has extensive knowledge of reporting osteopathic manipulative treatment (OMT). Contact the AAO for help finding solutions to your CPT and ICD-10 coding questions, examining Explanation of Benefits to understand claims denial, or drafting first- or second-level appeal letters. Fees may apply. The AAO will continue to analyze changes to existing payment policies to determine the impact on AAO members. For additional information, email the AAO at [email protected] or call the office at 317-879-1881. DEFINITIONSNew patient: A new patient is one who has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. Therefore, if an established patient has not received care from you or your group in the past 3 years, patient can be billed as a new patient. Group Practice: Physicians belonging to the same Medicare billing group identification in the same specialty. WHAT ARE THE CRITERIA FOR E&M VISITS?History
Other important information to help with grading your medical decision-making should include: Source of Information, e.g., patient, chart or other; miscellaneous information important to physicians, e.g., allergies, prior infectious diseases. Physical Exam
Medical Decision Making (MDM)
To establish how many systems are needed to determine a level of billing, please refer to www.cms.hhs.gov or www.acofp.org. ACCEPTABLE TIPS ON DOCUMENTATION
LIST OF CPT CODES
If you have any questions regarding physician services, billing and coding, reimbursement or practice-related issues, email us at [email protected]. AAO OSTEOPATHIC MEDICAL ECONOMICS SUBCOMMITTEEThe AAO Board of Trustees created the Osteopathic Medical Economics subcommittee as an informational resource for members dealing with difficulties regarding reimbursement for osteopathic manipulative treatment (OMT). The committee also reviews documents and audiovisual materials pertaining to medical economics issues, which can be used to influence coverage and reimbursement policies of third-party and legislators alike. The committee serves as a resource for members, insurance companies and attorneys who need access to osteopathic manipulative medicine experts for medical opinions, depositions, and court testimony. Accurate coding is a skill needed to correctly code for the services/procedures provided will have a positive Impact on your reimbursement. Current Procedural Terminology (CPT) codes and guidelines are accepted by the Centers for Medicare and Medicaid Services (CMS) and commercial payers. However, some Medicare contractors and commercial payers may have varying interpretations of some of the CPT guidelines. In addition, the American Osteopathic Association has many valuable resources for physicians in practice, including HIPAA guidance, billing and coding information, ICD-10 FAQs, a Medicare enrollment guide and advice for physician who are starting, selling or closing a practice. |